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2001-19 年,预防性初级保健就诊比例几乎翻了一番,尤其是在 Medicare 受益人群中。

Proportion Of Preventive Primary Care Visits Nearly Doubled, Especially Among Medicare Beneficiaries, 2001-19.

机构信息

Lisa S. Rotenstein (

John N. Mafi, University of California Los Angeles, Los Angeles, California; and RAND Corporation, Santa Monica, California.

出版信息

Health Aff (Millwood). 2023 Nov;42(11):1498-1506. doi: 10.1377/hlthaff.2023.00270.

Abstract

There is debate about the value of preventive visits in primary care, and multiple policy trends during the past fifteen years may have influenced the likelihood of US adults undergoing preventive primary care visits. Using nationally representative, serial cross-sectional data on adult visits to primary care physicians from the 2001-19 National Ambulatory Medical Care Survey, we characterized temporal trends in the proportion of primary care visits with a preventive focus and the differential characteristics of these visits. Based on a sample of 139,783 unweighted (5,902,144,258 weighted) US primary care visits, we found that the proportion of primary care visits with a preventive focus increased between 2001 and 2019 (12.8 percent of visits in 2001-02 versus 24.6 percent in 2018-19; [Formula: see text]), with the greatest rate of increase seen for people with Medicare. Primary care visits with a preventive focus involved more time spent with the physician and addressed fewer reasons for the visit compared with problem-based visits. At least one of the following was significantly more likely to occur during a preventive visit than a problem-based visit: counseling provision, ordering of preventive labs, or ordering of a preventive image or procedure. Our findings demonstrate a relative increase in preventive versus problem-based visits in primary care and suggest the importance of enhanced insurance coverage in influencing preventive care delivery trends.

摘要

关于初级保健中预防保健访问的价值存在争议,在过去十五年中,多项政策趋势可能影响了美国成年人进行预防初级保健访问的可能性。我们使用来自 2001-19 年全国门诊医疗保健调查的成人初级保健医生就诊的全国代表性、连续横断面数据,描述了以预防为重点的初级保健就诊比例的时间趋势,以及这些就诊的不同特征。基于未加权(5902144258 加权)的 139783 例美国初级保健就诊样本,我们发现,2001 年至 2019 年期间,以预防为重点的初级保健就诊比例有所增加(2001-02 年的 12.8%,2018-19 年的 24.6%;[公式:见正文]),其中 Medicare 参保人增幅最大。与基于问题的就诊相比,以预防为重点的就诊涉及与医生更多的就诊时间,并解决了较少的就诊原因。与基于问题的就诊相比,以下至少有一项在预防就诊中更有可能发生:提供咨询、预防性实验室检查、预防性影像或程序的订单。我们的研究结果表明,初级保健中预防就诊相对于基于问题的就诊呈相对增加趋势,并表明增强保险覆盖范围对影响预防保健服务提供趋势的重要性。

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